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1.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2022 Sep 19.
Article in English | MEDLINE | ID: covidwho-2097569

ABSTRACT

PURPOSE: This paper explores the role of hospital cleaners and their contribution to healthcare safety. Few studies have examined the activities and input of hospital cleaners, rendering them largely invisible in healthcare research. Yet, as coronavirus disease 2019 (COVID-19) has demonstrated, this sizeable workforce carries out tasks critical to healthcare facilities and wider health system functioning. DESIGN/METHODOLOGY/APPROACH: Drawing on the work of Habermas, the authors examine the literature surrounding cleaners and quality and safety in healthcare. The authors theorise cleaners' work as both instrumental and communicative and examine the perceptions of healthcare professionals and managers, as well as cleaners themselves, of healthcare professionals and managers' role and contribution to quality and safety. FINDINGS: Cleaners are generally perceived by the literature as performing repetitive - albeit important - tasks in isolation from patients. Cleaners are not considered part of the "healthcare team" and are excluded from decision-making and interprofessional communication. Yet, cleaners can contribute to patient care; ubiquity and proximity of cleaners to patients offer insights and untapped potential for involvement in hospital safety. ORIGINALITY/VALUE: This paper brings an overdue focus to this labour force by examining the nature and potential of their work. This paper offers a new application of Habermas' work to this domain, rendering visible how the framing of cleaners' role works to exclude this important workforce from participation in the patient safety agenda.


Subject(s)
COVID-19 , COVID-19/epidemiology , Hospitals , Humans , Patient Safety , Personnel, Hospital , Workforce
2.
Infect Control Hosp Epidemiol ; 42(6): 653-658, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-2096425

ABSTRACT

BACKGROUND: The pressures exerted by the coronavirus disease 2019 (COVID-19) pandemic pose an unprecedented demand on healthcare services. Hospitals become rapidly overwhelmed when patients requiring life-saving support outpace available capacities. OBJECTIVE: We describe methods used by a university hospital to forecast case loads and time to peak incidence. METHODS: We developed a set of models to forecast incidence among the hospital catchment population and to describe the COVID-19 patient hospital-care pathway. The first forecast utilized data from antecedent allopatric epidemics and parameterized the care-pathway model according to expert opinion (ie, the static model). Once sufficient local data were available, trends for the time-dependent effective reproduction number were fitted, and the care pathway was reparameterized using hazards for real patient admission, referrals, and discharge (ie, the dynamic model). RESULTS: The static model, deployed before the epidemic, exaggerated the bed occupancy for general wards (116 forecasted vs 66 observed), ICUs (47 forecasted vs 34 observed), and predicted the peak too late: general ward forecast April 9 and observed April 8 and ICU forecast April 19 and observed April 8. After April 5, the dynamic model could be run daily, and its precision improved with increasing availability of empirical local data. CONCLUSIONS: The models provided data-based guidance for the preparation and allocation of critical resources of a university hospital well in advance of the epidemic surge, despite overestimating the service demand. Overestimates should resolve when the population contact pattern before and during restrictions can be taken into account, but for now they may provide an acceptable safety margin for preparing during times of uncertainty.


Subject(s)
COVID-19/epidemiology , Hospital Bed Capacity , Hospitals, University/organization & administration , COVID-19/prevention & control , Cross Infection/prevention & control , Forecasting , Germany/epidemiology , Hospitals, University/statistics & numerical data , Humans , Incidence , Models, Statistical , Patient Safety
6.
Br J Nurs ; 31(18): 940-946, 2022 Oct 13.
Article in English | MEDLINE | ID: covidwho-2067261

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, healthcare organisations around the world had to optimise resources and redeploy staff to meet unprecedented demands on services. This service evaluation aims to establish the experiences of nurses redeployed to a COVID-negative Nightingale ward during the first wave of the pandemic in the UK. METHODS: Purposive sampling using a survey was used to capture nurses' experiences. Data were extrapolated to meet the aims of the thematic line of enquiry and descriptive statistics used to analyse the data set. RESULTS: The response rate was 34.0% (n=30). The majority of redeployees (76.7%; n=23) strongly agreed or agreed the trust induction had been beneficial. Informal learning, including from colleagues, was said to be very helpful by 50.0% (n=15) and helpful by 36.7% (n=10) of participants. Most (90.0%; n=27) agreed they were able to maintain safety, with 93.3% (n=28) satisfied with the quality of their care. Regarding giving the care they aspired to, 46.7% (n=14) strongly agreed and 40.0% (n=12) agreed they had been able to do this. CONCLUSION: The advanced clinical practitioner role was central to successful redeployment, in preparing redeployees through induction and education. These practitioners facilitated the acquisition of the knowledge and skills to deliver competent care, ensuring staff had the capacity and capability to undertake their job. Patient safety was not compromised by redeployment.


Subject(s)
COVID-19 , COVID-19/epidemiology , Delivery of Health Care , Hospitals , Humans , Pandemics , Patient Safety
7.
J Clin Psychiatry ; 82(2)2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-2066787

ABSTRACT

BACKGROUND: Most research evaluating telehealth psychiatric treatment has been conducted in outpatient settings. There is a great lack of research assessing the efficacy of telehealth treatment in more acute, intensive treatment settings such as a partial hospital. In the face of the COVID-19 pandemic, much of behavioral health treatment has transitioned to a virtual format. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examined the effectiveness of our partial hospital program (PHP). METHOD: The sample included 207 patients who were treated virtually from May 2020 to September 2020 and a comparison group of 207 patients who were treated in the in-person partial program a year earlier. Patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being. RESULTS: For both the in-person and telehealth methods of delivering partial hospital level of care, patients were highly satisfied with treatment and reported a significant reduction in symptoms and suicidality from admission to discharge. On the modified Remission from Depression Questionnaire, the primary outcome measure, both groups reported a significant (P < .01) improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment (Cohen d > 0.8) was found in both treatment groups. The only significant difference in outcome between the patients treated in the different formats was a greater length of stay (mean ± SD of 13.5 ± 8.1 vs 8.5 ± 5.0 days, t = 7.61, P < .001) and greater likelihood of staying in treatment until completion (72.9% vs 62.3%, χ2 = 5.34, P < .05) in the virtually treated patients. CONCLUSIONS: Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, suicidal ideation reduction, and improved functioning and well-being. The treatment completion rate was higher in the telehealth cohort, and several patients who were treated virtually commented that they never would have presented for in-person treatment even if there was no pandemic. Telehealth PHPs should be considered a viable treatment option even after the pandemic has resolved.


Subject(s)
Behavior Therapy , COVID-19 , Emergency Services, Psychiatric , Mental Disorders , Telemedicine , Adult , Behavior Therapy/methods , Behavior Therapy/trends , COVID-19/epidemiology , COVID-19/prevention & control , Emergency Service, Hospital/statistics & numerical data , Emergency Services, Psychiatric/methods , Emergency Services, Psychiatric/trends , Female , Hospitalization/statistics & numerical data , Humans , Infection Control/methods , Male , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Mental Disorders/therapy , Mental Health/trends , Patient Safety , Patient Satisfaction , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration , United States/epidemiology
8.
Int J Environ Res Public Health ; 19(19)2022 Sep 27.
Article in English | MEDLINE | ID: covidwho-2065937

ABSTRACT

Hospital-based emergency services are frequently criticized worldwide for their management, which can lead to a decrease in staff motivation, with a potential impact on patient safety. This article describes how harnessing the power of social networks can facilitate the management of emergency department teams. Beyond teaching, promoting emergency medicine and recruiting health professionals, these tools can unite employees around a virtual leader and help develop a true service culture. The concept of management through social networks is a novel manner to reach out to staff and should be further explored for use in the health care context.


Subject(s)
Emergency Medicine , Emergency Service, Hospital , Delivery of Health Care , Health Personnel , Humans , Patient Safety
9.
Br J Nurs ; 31(17): 912-913, 2022 Sep 22.
Article in English | MEDLINE | ID: covidwho-2056429

ABSTRACT

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses the need for careful consideration when looking to draw lessons from patient safety crises and clinical negligence claims.


Subject(s)
Malpractice , Patient Safety , Humans , Schools , State Medicine , United Kingdom
11.
Rev Lat Am Enfermagem ; 29: e3484, 2021 Nov 08.
Article in English, Spanish, Portuguese | MEDLINE | ID: covidwho-2054520
12.
Hu Li Za Zhi ; 69(5): 4-6, 2022 Oct.
Article in Chinese | MEDLINE | ID: covidwho-2040337

ABSTRACT

Patient safety is a primary concern in the medical and healthcare industry. The safety climate (or culture) of a hospital is determined by the overall perception of its safety policies and the safety-related behaviors of medical staff that affect the quality of care provided by the organization and risk of occupational injury. The perceptions of nurses related to the hospital safety climate relate positively to their behavior in the workplace. An organization's safety culture determines the risk of patient care. Patankar and Sabin (2010) identified safety values, safety leadership, safety climate, and safety performance as important factors affecting the development and improvement of an organization's safety climate. Several papers in the literature have examined the characteristics (Lin et al., 2017), influencing factors (Wagner et al., 2020), outcomes (Arzahan et al., 2022), and improvement strategies (Lee et al., 2019) related to hospital safety climates. The occupational safety of medical staff and their compliance with safety regulations relate closely to patient safety and care outcomes (Hessels & Larson, 2016). The most frequently used outcome indicators of hospital safety culture are mortality rate, length of stay, infection rates, and patient satisfaction. However, unsafe medical environments and work stress may hinder the compliance of medical staff with safety behaviors and affect the value they place on these behaviors. Furthermore, perceiving a working environment as "unsafe" induces physical and mental health problems and dissatisfaction, leading to work stress and causing occupational injuries, physical and mental health issues, increased turnover, and decreased work satisfaction (Arzahan et al., 2022; Kalteh et al., 2021). The working environment of nurses is highly complex and uncertain, and considered to be one of the most hazardous occupational settings. However, guaranteeing a safe and friendly working environment is the responsibility of every organization and also a basic employee right. The International Council of Nurses (International Council of Nurses, 2017) advocates that every nurse has the right to work in a healthy and safe environment that minimizes the risks of injury and illness. Therefore, patient health outcomes should not be the only focus when discussing hospital safety culture, and more attention should be paid to promoting a safe working environment for medical staff as well. In their study conducted in Taiwan, Lin et al. (2022) proposed that the safety climate of hospitals covers six dimensions. Three of these, including "experience of clinical jobs hindering the use of personal protective equipment," "perception of comfort using personal protective equipment," and "easy usage of personal protective equipment", have not been addressed in studies conducted elsewhere. These three dimensions, which all relate directly to work environment safety, earned relatively low mean scores from the nurses surveyed, with "comfort in using personal protective equipment" earning the lowest mean score of all. Although the safety of working environments in medical organizations includes many dimensions (International Council of Nurses, 2017), including biological (infection risk), chemical (chemotherapy drugs), ergonomic (improper design, lifting), physical (radiation, needle stick injuries), and psychological (workload, workplace violence), the accumulated evidence provides insights that administrators may use to further improve hospital safety environments. Lin et al. (2022)'s investigation of nursing management practices related to hazardous antineoplastic drugs found the availability of adequate and appropriate personal protective equipment to be essential to promoting a safe working environment. During the current coronavirus disease pandemic, the three Taiwan-specific dimensions related to personal protective equipment have great value in helping nurse administrators foster and assess the safety climate in their hospitals. In addition to showing that nurses use personal protective equipment for self-protection and the protection of clients, these dimensions also provide to nurse administrators specific directions for creating a safe working environment by providing to nurses adequate, comfortable, and easy-to-use personal protection equipment.


Subject(s)
Antineoplastic Agents , Patient Safety , Cross-Sectional Studies , Humans , Safety Management , Workplace/psychology
13.
Int J Environ Res Public Health ; 19(16)2022 08 16.
Article in English | MEDLINE | ID: covidwho-2023652

ABSTRACT

Patient safety has been a big theme in the area of global health, as represented by the resolution of the World Health Organization (WHO) on "Global action on patient safety" in 2019 and the recently published "Global Patient Safety Action Plan 2021-2030 [...].


Subject(s)
Burnout, Professional , Patient Safety , Burnout, Professional/prevention & control , Humans , Primary Health Care , World Health Organization
14.
J Ambul Care Manage ; 45(4): 299-309, 2022.
Article in English | MEDLINE | ID: covidwho-2018269

ABSTRACT

Investigation of nurses' perceptions of patient safety culture (PSC) might be beneficial in identifying safety areas that need improvement, especially during the COVID-19 pandemic. The study reports on the PSC in primary care from the nurses' perspective during the pandemic. Nurses (n = 117) evaluated teamwork (87.3%) and staff training (80.9%) positively but work pressure and pace (26.1%) and patient care tracking (45.3%) concerning PSC dimensions negatively. Limited care coordination and continuity lead to patient hospitalizations and care fragmentation. However, regular assessment of PSC can lead to adopting the necessary strategies to reinforce weaknesses and thus improve patient safety in primary care.


Subject(s)
COVID-19 , Nurses , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Organizational Culture , Pandemics , Patient Safety , Perception , Primary Health Care , Safety Management , Surveys and Questionnaires
15.
J Crit Care ; 71: 154094, 2022 10.
Article in English | MEDLINE | ID: covidwho-2015602

ABSTRACT

PURPOSE: To categorize, quantify and interpret findings documented in feedback letters of monitoring or auditing visits for an investigator-initiated, peer-review funded multicenter randomized trial testing probiotics for critically ill patients. MATERIALS & METHODS: In 37 Canadian centers, monitoring and auditing visits were performed by 3 trained individuals; findings were reported in feedback letters. At trial termination, we performed duplicate content analysis on letters, categorizing observations first into unique findings, followed by 10 pre-determined trial quality management domains. We further classified each observation into a) missing operational records, b) errors in process, and potential threats to c) data integrity, d) patient privacy or e) safety. RESULTS: Across 37 monitoring or auditing visits, 75 unique findings were categorized into 10 domains. Most frequently, observations were in domains of training documentation (180/566 [32%]) and the informed consent process (133/566 [23%]). Most observations were missing operational records (438/566 [77%]) rather than errors in process (128/566 [23%]). Of 75 findings, 13 (62/566 observations [11%]) posed a potential threat to data integrity, 1 (1/566 observation [0.18%]) to patient privacy, and 9 (49/566 observations [8.7%]) to patient safety. CONCLUSIONS: Monitoring and auditing findings predominantly concerned missing documentation with minimal threats to data integrity, patient privacy or safety. TRIAL REGISTRATION: PROSPECT (Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial): NCT02462590.


Subject(s)
Informed Consent , Patient Safety , Canada , Humans , Multicenter Studies as Topic
16.
Br J Anaesth ; 129(5): 647-649, 2022 11.
Article in English | MEDLINE | ID: covidwho-2014950

ABSTRACT

The response to the COVID-19 pandemic and the approach to patient safety share three important concepts: the challenges of preventing rare events, use of rules, and tolerance for uncertainty. We discuss how each of these ideas can be utilised in perioperative safety to create a high-reliability system.


Subject(s)
COVID-19 , Humans , Pandemics/prevention & control , Patient Safety , Reproducibility of Results , Uncertainty
17.
J Patient Saf ; 18(6): e912-e921, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-2005021

ABSTRACT

OBJECTIVES: Delayed emergency department (ED) and hospital patient throughput is recognized as a critical threat to patient safety. Increasingly, hospitals are investing significantly in deploying command centers, long used in airlines and the military, to proactively manage hospital-wide patient flow. This scoping review characterizes the evidence related to hospital capacity command centers (CCCs) and synthesizes current data regarding their implementation. METHODS: As no consensus definition exists for CCCs, we characterized them as units (i) involving interdisciplinary, permanently colocated teams, (ii) using real-time data, and (iii) managing 2 or more patient flow functions (e.g., bed management, transfers, discharge planning, etc.), to distinguish CCCs from transfer centers. We undertook a scoping review of the medical and gray literature published through April 2019 related to CCCs meeting these criteria. RESULTS: We identified 8 eligible articles (including 4 peer-reviewed studies) describing 7 CCCs of varying designs. The most common CCC outcome measures related to transfer volume (n = 5) and ED boarding (n = 4). Several CCCs also monitored patient-level clinical parameters. Although all articles reported performance improvements, heterogeneity in CCC design and evidence quality currently restricts generalizability of findings. CONCLUSIONS: Numerous anecdotal accounts suggest that CCCs are being widely deployed in an effort to improve hospital patient flow and safety, yet peer-reviewed evidence regarding their design and effectiveness is in its earliest stages. The costs, objectives, and growing deployment of CCCs merit an investment in rigorous research to better measure their processes and outcomes. We propose a standard definition, conceptual framework, research priorities, and reporting standards to guide future investigation of CCCs.


Subject(s)
Emergency Service, Hospital , Hospitals , Humans , Inpatients , Patient Discharge , Patient Safety
18.
J Adv Nurs ; 78(10): 3371-3384, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2001671

ABSTRACT

AIMS: To explore registered nurses' experiences of patient safety in intensive care during COVID-19. DESIGN: A qualitative interview study informed by constructivism. METHOD: Semi-structured interviews were conducted and audio-recorded with 19 registered nurses who worked in intensive care during COVID-19 between May and July 2021. Interviews were transcribed verbatim and thematically analysed utilizing framework. RESULTS: Two key themes were identified. 'On a war footing'-an unprecedented situation which describes the situation nurses faced, and the actions are taken to prepare for the safe delivery of care. 'Doing the best we can'-Safe Delivery of Care which describes the ramifications of the actions taken on short- and long-term patient safety including organization of care, missed and suboptimal care and communication. Both themes were embedded in the landscape of Staff Well-being and Peer Support. CONCLUSION: Nurses reported an increase in patient safety risks which they attributed to the dilution of skill mix and fragmentation of care. Nurses demonstrated an understanding of the holistic and long-term impacts on patient safety and recovery from critical illness. IMPACT: This study explored the perceived impact of COVID-19 on patient safety in intensive care from a nursing perspective. Dilution of skill mix, where specialist critical care registered nurses were diluted with registered nurses with no critical care experience, and the fragmentation of care was perceived to lead to reduced quality of care and increased adverse events and risk of harm which were not consistently formally reported. Furthermore, nurses demonstrated a holistic and long-term appreciation of patient safety. These findings should be considered as part of future nursing workforce modelling and patient safety strategies by intensive care leaders and managers. No public or patient contribution to this study. The study aims and objectives were developed in collaboration with health care professionals.


Subject(s)
COVID-19 , Nurses , Critical Care , Humans , Patient Safety , Qualitative Research
19.
J Nurs Care Qual ; 37(4): 313-318, 2022.
Article in English | MEDLINE | ID: covidwho-2001515

ABSTRACT

BACKGROUND: Staff shortages, reduced budgets, and high acuity of violent psychiatric patients can create challenges in psychiatric intensive care units (PICUs). LOCAL PROBLEM: Staffing of the psychiatric unit was based on patient census rather than evidence-based practices. METHODS: A pre-/postintervention design was used to examine changes in nursing satisfaction and patient outcomes as measured with the National Database of Nursing Quality Indicators (NDNQI) survey results. INTERVENTIONS: A psychiatric specific acuity tool was implemented on the PICU of a Veterans Administration hospital. RESULTS: After an initial decrease related to the COVID-19 pandemic, total acuity and the total number of nurses remained relatively stable while the unit census declined. NDNQI survey results improved with the largest being a 52-percentile increase for the quality-of-care summary measure. CONCLUSIONS: An acuity tool can help standardize practice, determine fair patient assignments among staff, increase nurse satisfaction, and promote best practices for patient safety.


Subject(s)
COVID-19 , Nursing Staff, Hospital , COVID-19/epidemiology , Humans , Intensive Care Units , Nursing Staff, Hospital/psychology , Pandemics , Patient Safety , Personnel Staffing and Scheduling
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